Engaging staff to improve quality and safety in an austere medical environment: A case-control study in two Sierra Leonean hospitals

Michael Rosen, Adaora M. Chima, John Sampson, Eric V. Jackson, Rahul Koka, Megan K. Marx, Thaim B. Kamara, Onyebuchi U. Ogbuagu, Benjamin H. Lee

Research output: Contribution to journalArticle

Abstract

Quality problem or issue: Inadequate observance of basic processes in patient care such as patient monitoring and documentation practices are potential impediments to the timely diagnoses and management of patients. These gaps exist in low resource settings such as Sierra Leone and can be attributed to a myriad of factors such as workforce and technology deficiencies. Initial assessment: In the study site, only 12.4% of four critical vital signs were documented in the pre-intervention period. Choice of solution: Implement a failure mode and effects analysis (FMEA) to improve documentation of four patient vital signs: temperature, blood pressure, pulse rate and respiratory rate. Implementation: FMEA was implemented among a subpopulation of health workers who are involved in monitoring and documenting patient vital signs. Pre- and post-FMEA monitoring and documentation practice were compared with a control site. Evaluation: Participants identified a four-step process to monitoring and documenting vital signs, three categories of failure modes and four potential solutions. Based on 2100 patient days of documentation compliance data from 147 patients between July and November 2012, staff members at the study site were 1.79 times more likely to document all four patient vital signs in the postimplementation period (95% CI [1.35, 2.38]). Lessons learned: FMEA is a feasible and effective strategy for improving quality and safety in an austere medical environment. Documentation compliance improved at the intervention facility. To evaluate the scalability and sustainability of this approach, programs targeting the development of these types of process improvement skills in local staff should be evaluated.

Original languageEnglish (US)
Pages (from-to)320-327
Number of pages8
JournalInternational Journal for Quality in Health Care
Volume27
Issue number4
DOIs
StatePublished - Aug 1 2015

Fingerprint

Vital Signs
Documentation
Case-Control Studies
Safety
Physiologic Monitoring
Compliance
Sierra Leone
Program Evaluation
Respiratory Rate
Patient Care
Heart Rate
Blood Pressure
Technology
Temperature
Healthcare Failure Mode and Effect Analysis
Health

Keywords

  • Appropriate health care
  • Developing countries
  • Experimental research
  • General methodology
  • Health-care system
  • Hospital care
  • Human factors
  • Organization science
  • Patient safety
  • Practice variations
  • Qualitative methods
  • Quality improvement
  • Quality management
  • Setting of care
  • Specific populations

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health

Cite this

Engaging staff to improve quality and safety in an austere medical environment : A case-control study in two Sierra Leonean hospitals. / Rosen, Michael; Chima, Adaora M.; Sampson, John; Jackson, Eric V.; Koka, Rahul; Marx, Megan K.; Kamara, Thaim B.; Ogbuagu, Onyebuchi U.; Lee, Benjamin H.

In: International Journal for Quality in Health Care, Vol. 27, No. 4, 01.08.2015, p. 320-327.

Research output: Contribution to journalArticle

Rosen, Michael ; Chima, Adaora M. ; Sampson, John ; Jackson, Eric V. ; Koka, Rahul ; Marx, Megan K. ; Kamara, Thaim B. ; Ogbuagu, Onyebuchi U. ; Lee, Benjamin H. / Engaging staff to improve quality and safety in an austere medical environment : A case-control study in two Sierra Leonean hospitals. In: International Journal for Quality in Health Care. 2015 ; Vol. 27, No. 4. pp. 320-327.
@article{bf39f78fabf247afb36f9054c56eb1ef,
title = "Engaging staff to improve quality and safety in an austere medical environment: A case-control study in two Sierra Leonean hospitals",
abstract = "Quality problem or issue: Inadequate observance of basic processes in patient care such as patient monitoring and documentation practices are potential impediments to the timely diagnoses and management of patients. These gaps exist in low resource settings such as Sierra Leone and can be attributed to a myriad of factors such as workforce and technology deficiencies. Initial assessment: In the study site, only 12.4{\%} of four critical vital signs were documented in the pre-intervention period. Choice of solution: Implement a failure mode and effects analysis (FMEA) to improve documentation of four patient vital signs: temperature, blood pressure, pulse rate and respiratory rate. Implementation: FMEA was implemented among a subpopulation of health workers who are involved in monitoring and documenting patient vital signs. Pre- and post-FMEA monitoring and documentation practice were compared with a control site. Evaluation: Participants identified a four-step process to monitoring and documenting vital signs, three categories of failure modes and four potential solutions. Based on 2100 patient days of documentation compliance data from 147 patients between July and November 2012, staff members at the study site were 1.79 times more likely to document all four patient vital signs in the postimplementation period (95{\%} CI [1.35, 2.38]). Lessons learned: FMEA is a feasible and effective strategy for improving quality and safety in an austere medical environment. Documentation compliance improved at the intervention facility. To evaluate the scalability and sustainability of this approach, programs targeting the development of these types of process improvement skills in local staff should be evaluated.",
keywords = "Appropriate health care, Developing countries, Experimental research, General methodology, Health-care system, Hospital care, Human factors, Organization science, Patient safety, Practice variations, Qualitative methods, Quality improvement, Quality management, Setting of care, Specific populations",
author = "Michael Rosen and Chima, {Adaora M.} and John Sampson and Jackson, {Eric V.} and Rahul Koka and Marx, {Megan K.} and Kamara, {Thaim B.} and Ogbuagu, {Onyebuchi U.} and Lee, {Benjamin H.}",
year = "2015",
month = "8",
day = "1",
doi = "10.1093/intqhc/mzv030",
language = "English (US)",
volume = "27",
pages = "320--327",
journal = "International Journal for Quality in Health Care",
issn = "1353-4505",
publisher = "Oxford University Press",
number = "4",

}

TY - JOUR

T1 - Engaging staff to improve quality and safety in an austere medical environment

T2 - A case-control study in two Sierra Leonean hospitals

AU - Rosen, Michael

AU - Chima, Adaora M.

AU - Sampson, John

AU - Jackson, Eric V.

AU - Koka, Rahul

AU - Marx, Megan K.

AU - Kamara, Thaim B.

AU - Ogbuagu, Onyebuchi U.

AU - Lee, Benjamin H.

PY - 2015/8/1

Y1 - 2015/8/1

N2 - Quality problem or issue: Inadequate observance of basic processes in patient care such as patient monitoring and documentation practices are potential impediments to the timely diagnoses and management of patients. These gaps exist in low resource settings such as Sierra Leone and can be attributed to a myriad of factors such as workforce and technology deficiencies. Initial assessment: In the study site, only 12.4% of four critical vital signs were documented in the pre-intervention period. Choice of solution: Implement a failure mode and effects analysis (FMEA) to improve documentation of four patient vital signs: temperature, blood pressure, pulse rate and respiratory rate. Implementation: FMEA was implemented among a subpopulation of health workers who are involved in monitoring and documenting patient vital signs. Pre- and post-FMEA monitoring and documentation practice were compared with a control site. Evaluation: Participants identified a four-step process to monitoring and documenting vital signs, three categories of failure modes and four potential solutions. Based on 2100 patient days of documentation compliance data from 147 patients between July and November 2012, staff members at the study site were 1.79 times more likely to document all four patient vital signs in the postimplementation period (95% CI [1.35, 2.38]). Lessons learned: FMEA is a feasible and effective strategy for improving quality and safety in an austere medical environment. Documentation compliance improved at the intervention facility. To evaluate the scalability and sustainability of this approach, programs targeting the development of these types of process improvement skills in local staff should be evaluated.

AB - Quality problem or issue: Inadequate observance of basic processes in patient care such as patient monitoring and documentation practices are potential impediments to the timely diagnoses and management of patients. These gaps exist in low resource settings such as Sierra Leone and can be attributed to a myriad of factors such as workforce and technology deficiencies. Initial assessment: In the study site, only 12.4% of four critical vital signs were documented in the pre-intervention period. Choice of solution: Implement a failure mode and effects analysis (FMEA) to improve documentation of four patient vital signs: temperature, blood pressure, pulse rate and respiratory rate. Implementation: FMEA was implemented among a subpopulation of health workers who are involved in monitoring and documenting patient vital signs. Pre- and post-FMEA monitoring and documentation practice were compared with a control site. Evaluation: Participants identified a four-step process to monitoring and documenting vital signs, three categories of failure modes and four potential solutions. Based on 2100 patient days of documentation compliance data from 147 patients between July and November 2012, staff members at the study site were 1.79 times more likely to document all four patient vital signs in the postimplementation period (95% CI [1.35, 2.38]). Lessons learned: FMEA is a feasible and effective strategy for improving quality and safety in an austere medical environment. Documentation compliance improved at the intervention facility. To evaluate the scalability and sustainability of this approach, programs targeting the development of these types of process improvement skills in local staff should be evaluated.

KW - Appropriate health care

KW - Developing countries

KW - Experimental research

KW - General methodology

KW - Health-care system

KW - Hospital care

KW - Human factors

KW - Organization science

KW - Patient safety

KW - Practice variations

KW - Qualitative methods

KW - Quality improvement

KW - Quality management

KW - Setting of care

KW - Specific populations

UR - http://www.scopus.com/inward/record.url?scp=84939640112&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84939640112&partnerID=8YFLogxK

U2 - 10.1093/intqhc/mzv030

DO - 10.1093/intqhc/mzv030

M3 - Article

C2 - 26060230

AN - SCOPUS:84939640112

VL - 27

SP - 320

EP - 327

JO - International Journal for Quality in Health Care

JF - International Journal for Quality in Health Care

SN - 1353-4505

IS - 4

ER -